ObjectiveTo investigate the feasibility of video-assisted thoracoscopic surgery (VATS) lung resection in the treatment of tuberculosis.MethodsWe retrospectively analyzed the clinical data of 164 tuberculosis patients who underwent lung resection in Xi'an Chest Hospital from 2013 to 2017. Patients were divided into two groups according to the surgical procedure: a VATS group (85 patients, 56 males and29 females) and a thoracotomy group (79 patients, 52 males and 27 females). The clinical effect of the two groups was compared.Results Compared to the thoracotomy group, the VATS group had less operation time (151.59±76.75 min vs. 233.48±93.89 min, P<0.001), amount of intraoperative blood loss (200.00 ml vs. 600.00 ml, P<0.001), the postoperative drainage (575.00 ml vs. 1 110.00 ml, P=0.001), extubation time (4 d vs. 6 d, P<0.001) and hospital stay (13.00 d vs. 17.00 d, P<0.001). There was no statistical difference in postoperative complications (10 patients vs.17 patients, P=0.092) between the two groups. A total of 97 patients underwent lobectomy, including 36 of the VATS group and 61 of the thoracotomy group. The operation time (211.39±70.88 min vs. 258.20±87.16 min, P=0.008), the intraoperative blood loss (400.00 ml vs. 700 ml, P<0.010), the postoperative drainage (800.00 ml vs. 1 250.00 ml, P=0.001), extubation time (5.00 d vs. 8.00 d, P=0.002) and hospital stay (13.11±4.45 d vs. 19.46±7.74 d, P<0.010) in the VATS group were significantly better than those in the thoracotomy group. There was no statistical difference in postoperative complication rate (4 patients vs. 14 patients, P=0.147) between the two[1], groups.ConclusionCompared with conventional thoracotomy, VATS lung resection has obvious advantages in treatment of tuberculosis, which may be the preferred technique.
Objective To systematically review the safety of rifapentine vs. rifampicin for pulmonary tuberculosis. Methods PubMed, EMbase, The Cochrane Library, CBM, VIP, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) of rifapentine vs. rifampicin for pulmonary tuberculosis up to September 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software. Results A total of 26 RCTs involving 3 624 cases were included. The results of meta-analysis showed that the rifapentine group was superior to the rifampicin group on the incidence of abnormal liver function (RR=0.31, 95%CI 0.32 to 0.47, P<0.000 01), skin rash occurrence rate (RR=0.24, 95%CI 0.16 to 0.37,P<0.000 01), the incidence of leukopenia (RR=0.41, 95%CI 0.31 to 0.54,P<0.000 01), and the incidence of gastrointestinal reaction (RR=0.46, 95%CI 0.37 to 0.57,P<0.000 01) with statistical significance. Conclusions Current evidence shows that compared with rifampicin, rifapentine can effectively reduce the adverse reactions of patients. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo investigate the diagnostic value of products triggered by endotoxin including cytokines and procalcitonin for differentiating bacterial pneumonia from pulmonary tuberculosis. MethodsFifty patients diagnosed to have hospital-acquired pneumonia and another 50 patients diagnosed with tuberculosis admitted into West China Hospital between January and August 2015 were recruited in this study. The frequencies of CD4+ interferon (IFN)-γ+, CD4+ tumor necrosis factor (TNF)-α+, CD4+ interleukin (IL)-2+, CD4+ IL-10+ as well as CD8+IFN-γ+, CD8+TNF-α+, CD8+IL-2+, CD8+IL-10+ populations in peripheral blood were detected by flow cytometry after endotoxin stimulation. Meanwhile, the levels of procalcitonin, IL-6 and C reactive protein were measured by immunofluorescence staining. ResultsThe frequencies of CD4+ IFN-γ+, CD4+ TNF-α+, CD4+ IL-2+, CD4+ IL-10+ as well as CD8+ IFN-γ+, CD8+ TNF-α+, CD8+ IL-2+, CD8+ IL-10+ populations in the pneumonia group increased significantly compared with those in the tuberculosis group (P < 0.05). The levels of procalcitonin, IL-6 and C-reactive protein in the pneumonia group increased statistically compared with the counterparts in the tuberculosis group (P < 0.05). The positive rates of procalcitonin, IL-6 and C-reactive protein in the pneumonia group were significantly higher than those in the tuberculosis group (P < 0.05). ConclusionMeasurement of products triggered by endotoxin is beneficial for differential diagnosis of pneumonia from tuberculosis.
The significant increase in mortality after tuberculosis (TB) progression to severe disease is a major obstacle to achieving the goal of ending the TB epidemic by 2035. Up to now, there is no clear definition and diagnostic criteria for adult severe tuberculosis at home or abroad, which has a significant adverse impact on the early diagnosis and timely treatment of patients with severe tuberculosis. In order to improve the treatment level of patients with severe pulmonary tuberculosis, reduce mortality and improve prognosis. The Professional Committee of Tuberculosis Science of the Chinese Society of Research Hospitals and Shenzhen Third People's Hospital/National Clinical Medical Research Center of Infectious Diseases/Shenzhen Tuberculosis Clinical Medical Research Center led the formulation of "Guidelines for definition and diagnosis of severe pulmonary tuberculosis in adults in China (2023)", aiming to guide and standardize the definition and diagnosis of severe tuberculosis. So as to improve the level of diagnosis and treatment of severe pulmonary tuberculosis in our country, to maximize the benefit of patients.
ObjectiveTo analyze the incidence of complications, duration of chest tube indwelling, and nutritional status in tuberculosis (TB) patients undergoing pulmonary surgery, and to explore perioperative nutritional management strategies and rehabilitation measures by identifying nutritional factors influencing postoperative chest tube duration. MethodsA retrospective analysis was conducted on clinical data of TB patients who underwent lobectomy at the Department of Thoracic Surgery, Chengdu Public Health Clinical Medical Center from 2022 to 2023. Patients were grouped based on chest tube duration (≤7 days vs. >7 days) and propensity score matching (PSM) was performed. Complications, drainage volume, and nutritional status were compared between groups. Univariate and multivariate logistic regression analyses were used to identify factors associated with prolonged chest tube duration. ResultsAmong 276 enrolled patients, 163 had chest tube duration ≤7 days [pre-PSM: 91 males, 72 females, mean age of (34.88±14.10) years] and 113 had duration >7 days [pre-PSM: 69 males, 44 females, mean age of (39.04±13.28) years]. After PSM (45 patients per group), no significant differences were observed in pleural or pulmonary infection rates between groups (P>0.05). Univariate analysis revealed statistical differences in preoperative albumin-to-globulin ratio (A/G), 24-hour postoperative A/G, 24-hour postoperative prognostic nutritional index (PNI), pre-discharge A/G, and pre-discharge hemoglobin (P<0.05). Multivariate logistic regression identified the following independent risk factors for prolonged chest tube duration: preoperative A/G, 24-hour postoperative A/G, 24-hour postoperative PNI, pre-discharge A/G, and pre-discharge hemoglobin. ConclusionPreoperative A/G, 24-hour postoperative A/G and PNI, and pre-discharge A/G and hemoglobin significantly influence chest tube duration in TB patients. Preoperative nutritional-immunological indicators independently predict prolonged drainage, while dynamic postoperative monitoring provides comprehensive recovery assessment. Integrating these parameters enables early identification of high-risk patients, facilitates personalized drainage management, and may reduce hospitalization duration while improving prognosis.
ObjectiveTo analyze the influencing factors for postoperative thoracic drainage duration in patients with cavitary pulmonary tuberculosis and clinical nursing strategies. MethodsA retrospective analysis was conducted on the clinical data of patients with cavitary pulmonary tuberculosis who underwent surgical treatment in the Department of Thoracic Surgery at Public Health Clinical Center of Chengdu from December 2022 to December 2024. Patients with a drainage time ≤7 days were included in the recovery group, while those with a drainage time >7 days were included in the control group. Data on patients' preoperative Hamilton anxiety and depression scores, perioperative nursing conditions were collected, and factors affecting chest drainage time were analyzed. ResultsA total of 186 patients were included in this study, including 119 males and 67 females, with an average age of (36.10±15.20) years. The average chest drainage tube retention time was (10.59±9.24) days. Preoperative Hamilton anxiety and depression assessments showed that 47.31% (88/186) of patients were anxious, and 31.72% (59/186) were depressed. Multivariate analysis indicated that having a smoking history, undergoing open-chest surgery, prolonged postoperative use of analgesic pumps, preoperative anxiety, and depression were independent risk factors for chest drainage time >7 days (P<0.05); frequent coughing and longer average daily activity time postoperatively were protective factors for chest drainage time >7 days (P<0.05). ConclusionPatients undergoing surgery for pulmonary tuberculosis often experience anxiety and depression preoperatively. In the clinical nursing of patients with cavitary pulmonary tuberculosis, efforts should be made preoperatively to help patients adjust their anxious and depressed emotions, control smoking, and prefer minimally invasive surgery; postoperatively, reducing analgesic duration, increasing cough frequency, promoting effective coughing, and extending average daily activity time can effectively shorten the postoperative chest drainage time, facilitating the rapid recovery of patients after surgery for pulmonary tuberculosis.
ObjectiveTo observe the impact of perioperative nursing intervention on pulmonary tuberculosis patients undergoing lung resection. MethodThirty-six pulmonary tuberculosis patients going to undergo lung resection hospitalized between January and December 2013 were randomly divided into intervention group and control group with 18 in each. Patients in the intervention group received routine perioperative care plus nursing intervention including preoperative, environmental, dieting and pain intervention. Then, complications, hospitalization time and costs, as well as patients' satisfaction with the nursing work were compared between the two groups. ResultsAfter nursing intervention, complications, hospitalization time, hospital costs of patients in the intervention group were significantly less than the control group (P<0.05), and patients' satisfaction was significantly higher (P<0.05). ConclusionsPerioperative nursing intervention on lung resection treatment and rehabilitation of patients play an active and effective role, which can reduce complications, shorten hospitalization time, reduce hospital costs and improve patients' satisfaction.
【摘要】 目的 探讨综合性医院内获得性免疫缺陷综合征（acquired immune deficiency syndrome，AIDS）患者的肺部表现及其特征。 方法 回顾性分析2006年2月－2009年12月收治的58例AIDS患者肺部病变的临床资料。 结果 58例患者中男47例，女11例，男女比例为4.27∶1；年龄6~78岁，平均43岁，其中lt;50岁者36例，占62.1%，gt;50岁22例，占37.9%。肺部表现是AIDS患者入住综合性医院的常见临床表现，居各种临床表现的首位（占55.2%）。主要有弥漫性肺部疾病和肺结核，分别是21例（36.2%）和23例（39.7%），收治的主要科室是呼吸内科38例（65.5%）和传染科12例（20.7%）；常见的临床症状有发热、咳嗽、活动后气促或呼吸困难；其肺部影像学表现多样，有毛玻璃样变、弥漫性结节影、斑片影、肺内块影或肺内空洞、纤维条索影或伴胸水；其常见伴随症状有口腔溃疡真菌、腹泻或其他消化道症状，及其皮疹、贫血、神经系统症状等；同时也有部分患者合并乙型肝炎病毒/丙型肝炎病毒/梅毒等混合感染。 结论 AIDS的肺部病变是综合性医院住院AIDS患者的主要表现，提高呼吸科医师对AIDS患者肺部表现的认识将有利于AIDS的临床防治。【Abstract】 Objective To investigate the clinical characteristics of acquired immune deficiency syndrome (AIDS) with pulmonary diseases in comprehensive hospitals. Methods The clinical data of 58 cases of AIDS with pulmonary diseases admitted in our hospital from 2006 to 2009 were analysed retrospectively. Results Among the patients, there were 47 males and 11 females, and the proportion of the number of males to females was 4.27∶1. Their age ranged from 6 to 78 years old, averaging at 43. Thirty-six patients (62.07%) were under 50 years old; and there were 22 patients (37.93%) aged 50 or above. The pulmonary expression was common in AIDS patients admitted into comprehensive hospitals, occupying the first place in various clinical manifestatiosn (55.24%). Pulmonary expressions of AIDS were mainly diffuse pulmonary diseases and pulmonary tuberculosis, which had 21 (36.21%) and 23 (39.66%) cases respectively. Chief treating departments were Department of Respiratory Medicine (65.52%) and Department of Infective Diseases (20.69%). Its common symptoms included fever, cough, shortness of breath after activities or dyspnea; Its pulmonary image had various manifestations including ground-glass opacity (GGO), diffuse nodal shadow, spot and thin piece shadow, pulmonary chunk shadow or cavity, fibre twigs shadow or/and hydrothorax; Its common combined symptoms included oral cavity ulcer fungus infection, diarrhoea or other digestive tract symptoms, and erythra, anemia, and nervus system symptoms, etc. There were still some other cases of combined viral hepatitis type B, type C, or syphilis. Conclusion Pulmonary diseases of AIDS are the main expressions of patients with AIDS in comprehensive hospitals. It will be beneficial to clinical prophylaxis and treatment of AIDS to heighten the knowledge of respiratory physicians on pulmonary expressions of patients with AIDS.